Teaching the health advocacy role in family medicine: Trial and error

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Factors influencing abortion decision-making processes among young women

Background: Decision-making about if and how to terminate a pregnancy is a dilemma for young women experiencing an unwanted pregnancy. Those women are subject to sociocultural and economic barriers that limit their autonomy and make them vulnerable to pressures that influence or force decisions about abortion. Objective: The objective of this study was to explore the individual, interpersonal and environmental factors behind the abortion decision-making process among young Mozambican women. Methods: A qualitative study was conducted in Maputo and Quelimane. Participants were identified during a cross-sectional survey with women in the reproductive age (15-49). In total, 14 women aged 15 to 24 who had had an abortion participated in in-depth interviews. A thematic analysis was used. Results: The study found determinants at different levels, including the low degree of autonomy for women, the limited availability of health facilities providing abortion services and a lack of patient-centeredness of health services. Conclusions: Based on the results of the study, the authors suggest strategies to increase knowledge of abortion rights and services and to improve the quality and accessibility of abortion services in Mozambique

Adult and young women communication on sexuality : a pilot intervention in Maputo-Mozambique

Background: Communication on sexuality within the family has been considered a determinant factor for the sexual behaviour of young women, contributing to delaying sexual initiation. Taking into account that young women are increasingly exposed to sexualized messages, they need clear, trustful and open communication on sexuality more than ever. However, in Mozambique, communication about sexuality is hampered by strict social norms. This paper evaluates the case of an intervention aimed at reducing the generational barrier for talking about sexuality and to contribute to better communication within the family context. Methods: The intervention consisted of three weekly one-hour coached sessions in which female adults and young interacted about sexuality. Realist evaluation was used as a framework to assess context, mechanisms, and outcomes of the intervention. Interviews were conducted among 13 participants of the sessions. Result: The interaction sessions were positively appreciated by the participants and contributed to change norms and attitudes towards communication on sexuality within families. Recognition of similarities and awareness of differences were key in the mechanisms leading to these outcomes. This was reinforced by the use of visual materials and the atmosphere of respect and freedom of speech that characterized the interactions. Limiting factors were related to the long-standing taboo on sexuality and existing misconceptions on sexuality education and talks about sex. Conclusion: By elucidating mechanisms and contextual factors our study adds knowledge on strategies to improve transgenerational communication about sexuality

Inter-professional collaboration reduces the burden of caring for patients with mental illnesses in primary healthcare. A realist evaluation study

Background:The implementation of primary care for mental health is often insufficient, whichleaves its mark on staff. A team-based approach of mental healthcare prevents poor staff mor-ale. A community health centre (CHC), therefore, set up a project promoting interprofessionalcollaboration with a mental health team (MHT).Objectives:This study aimed to understand how an MHT would influence staff morale in a pri-mary care setting, aiming to formulate some recommendations for future projects.Methods:In 2017, interviews and a focus group discussion were conducted among the staff ofa CHC. Using a qualitative approach, we aimed to unravel contextual factors and mechanismsthat determine the effect of an MHT on staff morale.Results:The project relieved the burden of the patient encounters and staff members felt morevaluable to patients. Underlying mechanisms were recognition, altered attitudes towards patientsand role clarity. Facilitating factors were intercultural care mediators and a positive team atmos-phere, whereas inhibiting factors were inefficient time management and communicative issues.Conclusion:Our study elucidated mechanisms and the contextual factors by which an MHT ingeneral practice improves staff morale

Por uma caracterização dos constituintes textuais desgarrados como comentários parentéticos à luz de uma perspectiva modular da organização do discurso

For Decat (2011), the unattachment of constituents corresponds to structures that occur freely, without being syntactically linked to a clause or any other textual portion. In this paper, we show that constituent unattachment can be studied in the framework of the Modular Approach to Discourse Analysis. More specifically, we extend to the study of unattached constituents Roulet’s (2004) proposal for the treatment of parenthetic constituents. In this paper, we will study the phenomenon of unattachment in three stages. In the first, we will study the textual relationship that links an unattached constituent to information previously expressed in the text. In the second step, we will analyze the action relation that articulates the unattached constituent to the previously performed actions. Finally, the third stage studies unattached constituents from the point of view of the operational organization form. In this last stage, the results of the previous stages will be combined to understand the discursive motivations of the unattachment. In the different stages, the unattached constituents that we will analyze were extracted from media texts, such as reports and opinion articles.Neste trabalho, nosso intuito é evidenciar que o desgarramento de constituintes, visto por Decat (2011) como estruturas que ocorrem livremente, sem estarem vinculadas sintaticamente a nenhuma oração ou nenhuma outra porção textual, pode ser estudado à luz de uma abordagem da Linguística do Texto e do Discurso, o Modelo de Análise Modular do Discurso. Mais especificamente, estendemos ao estudo dos constituintes desgarrados a proposta de Roulet (2004) para o tratamento dos constituintes parentéticos. Neste trabalho, seguiremos um percurso de análise que estudará o fenômeno do desgarramento em três etapas. Na primeira, estudaremos a relação textual que liga um constituinte desgarrado a uma informação previamente abordada no texto. Na segunda etapa, analisaremos a relação praxiológica que articula a ação que se realiza com o constituinte desgarrado às ações previamente realizadas. Por fim, a terceira etapa estuda os constituintes desgarrados do ponto de vista da forma de organização operacional. Nessa última etapa, os resultados das etapas anteriores serão combinados com o fim de compreendermos as motivações discursivas para o emprego dos constituintes desgarrados. Nas diferentes etapas, os constituintes desgarrados que analisaremos foram extraídos de textos da mídia, como reportagens e artigos de opinião

Optimization of quantitative polymerase chain reactions for detection and quantification of eight periodontal bacterial pathogens

BACKGROUND: The aim of this study was to optimize quantitative (real-time) polymerase chain reaction (qPCR) assays for 8 major periodontal pathogens, i.e. Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Parvimonas micros, Porphyromonas gingivalis, Prevotella intermedia, Tanerella forsythia and Treponema denticola, and of the caries pathogen Streptococcus mutans. RESULTS: Eighteen different primer pairs were analyzed in silico regarding specificity (using BLAST analysis) and the presence of secondary structures at primer binding sites (using mFOLD). The most specific and efficiently binding primer pairs, according to these analyses, were selected for qPCR-analysis to determine amplification efficiency, limit of quantification and intra-run reproducibility. For the selected primer pairs, one for each species, the specificity was confirmed by assessing amplification of DNA extracts from isolates of closely related species. For these primer pairs, the intercycler portability was evaluated on 3 different thermal cyclers (the Applied Biosystems 7300, the Bio-Rad iQ5 and the Roche Light Cycler 480). For all assays on the different cyclers, a good correlation of the standard series was obtained (i.e. r2 >= 0.98), but quantification limits varied among cyclers. The overall best quantification limit was obtained by using a 2 mul sample in a final volume of 10 mul on the Light Cycler 480. CONCLUSIONS: In conclusion, the proposed assays allow to quantify the bacterial loads of S. mutans, 6 periodontal pathogenic species and the genus Fusobacterium.This can be of use in assessing periodontal risk, determination of the optimal periodontal therapy and evaluation of this treatment

Community health workers as a strategy to tackle psychosocial suffering due to physical distancing : a randomized controlled trial

Background: During the COVID-19 pandemic, many primary care professionals were overburdened and experienced difficulties reaching vulnerable patients and meeting the increased need for psychosocial support. This randomized controlled trial (RCT) tested whether a primary healthcare (PHC) based community health worker (CHW) intervention could tackle psychosocial suffering due to physical distancing measures in patients with limited social networks. Methods: CHWs provided 8 weeks of tailored psychosocial support to the intervention group. Control group patients received ‘care as usual’. The impact on feelings of emotional support, social isolation, social participation, anxiety and fear of COVID-19 were measured longitudinally using a face-to-face survey to determine their mean change from baseline. Self-rated change in psychosocial health at 8 weeks was determined. Results: We failed to find a significant effect of the intervention on the prespecified psychosocial health measures. However, the intervention did lead to significant improvement in self-rated change in psychosocial health. Conclusions: This study confirms partially the existing evidence on the effectiveness of CHW interventions as a strategy to address mental health in PHC in a COVID context. Further research is needed to elaborate the implementation of CHWs in PHC to reach vulnerable populations during and after health crises